More than 4,700 miles and an ocean away from Memphis, Tennessee, 20 world-renowned infectious diseases experts gather to determine elements of an important vaccine that has worldwide implications. When it comes to making decisions about influenza, St. Jude Children’s Research Hospital has two seats at the table.

St. Jude virologists Richard Webby, PhD, and Stacey Schultz-Cherry, PhD, participate in the semiannual meetings of the World Health Organization (WHO) in Geneva, Switzerland. They are joined by experts from such cities as Beijing, London and Melbourne.

Who needs a whiteboard? Richard Webby, PhD, scribbles notes on a window as he and a colleague track the latest movement of influenza viruses.

“Recent years have brought an unprecedented number of human infections from animal flu viruses, including H1N1, H7N9 and H5N1,” says Webby, who directs the St. Jude-based WHO Collaborating Center for Studies on the Ecology of Influenza in Animals and Birds. “It’s pertinent for us to keep track of the viruses and provide recommendations, which help guide public health authorities as they prepare the upcoming flu vaccines.”

A global leader

For almost five decades, St. Jude has been a global leader in influenza research. The study of diseases such as flu is critical to cancer patients because the treatments they endure diminish their immune systems and put them at risk for infections.

“The question often asked of me is, ‘Why are you working with influenza in a cancer institute?’” says virologist Robert Webster, PhD, who holds the hospital’s Rose Marie Thomas Chair in Infectious Diseases. “It’s the infectious diseases—the simple, everyday diseases like measles and influenza—that pose serious risks to our children. Studying influenza is a very important component of St. Jude.”

Flu infections remain a leading cause of illness and death worldwide. During an average U.S. flu season, the virus is linked to approximately 36,000 deaths and 114,000 hospitalizations. The highly contagious disease poses a serious risk to the extremely old and young, as well as to cancer patients and others with compromised immune systems.

The WHO group meets to determine recommendations twice a year—February and September—as it could take up to eight months to produce flu vaccines. Along with looking at the most recent vaccine’s effectiveness, the experts assess flu activity in particularly virulent flu viruses, discuss surveillance and response systems, and “create antigenic and genetic characteristics of current flu strains to develop candidate vaccine strains for flu viruses,” Webby says.

Webster is internationally recognized as an expert in understanding, tracking and combating flu and advancing knowledge of how new flu strains evolve.

“When I started at St. Jude in 1968, we had no idea where these pandemics of influenza came from,” he says. “We started with the WHO studying wild birds, and over the years established firmly that the source of all influenza A viruses in the world comes from the aquatic birds.”

As a result of the initial studies, the WHO approached St. Jude to become a collaborating center in 1975. “We are particularly interested in understanding how some avian flu viruses jump from infecting birds to infecting humans and other mammals while others do not,” Webster says.

St. Jude is also one of five U.S. research institutions designated as a Center of Excellence for Influenza Research and Surveillance by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health. The collaboration unites basic and clinical researchers to advance understanding and response to flu, especially pandemic flu strains that pose a global health threat. At St. Jude, the federal funds help support an international flu surveillance network focused on wild birds and domestic animals.

Recent research

Within the past year, St. Jude has increased the world’s knowledge about influenza. One study provided evidence that the immune system can help predict which flu patients will develop severe symptoms and become hospitalized. The findings also help explain the reasons infants and toddlers have a higher risk for developing complications from the flu.

“This suggests there is an immune signature that could help doctors identify who needs closer monitoring or maybe more aggressive treatment,” says Paul Thomas, PhD, of St. Jude Immunology. “Clinically, we need to explore targeted therapies to address this problem separately from efforts to clear the virus.”

A study led by Webster found that descendants of the H2N2 avian flu A virus that killed millions worldwide in the 1950s still pose a threat to human health, particularly to those under age 50, because they lack immunity to the virus.

“This highlights the importance of continued surveillance of viruses circulating in animals and additional research to enhance our ability to identify viruses that are emerging health threats,” Webster says.

The future of flu

Flu remains a global health threat, from viruses that have been circulating for generations to the first North American case of H1N1 in January 2014.

St. Jude scientists are at the forefront of unraveling this threat—focusing their efforts on emerging flu strains, circulating viruses and global strategy. In addition to surveillance, the researchers are studying the human immune response to flu; risk factors such as obesity, which are associated with flu complications; flu transmission; and ecological factors that help maintain H5N1 avian flu presence in Southeast Asia poultry populations.

“We study such viruses as H5N1 and H7N9— specifically concentrating on the human-animal interface,” Webby says. “We’re trying to understand how much of these viruses are out there and exactly what it takes for them to become human pathogens—to go human to human.”